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Iowa rates for HCPCS A9604

Samarium Sm-153 lexidronam, therapeutic, per treatment dose, up to 150 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19,539.50 / $19,539.50 / $54,996.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,631.57 / $15,631.57 / $19,539.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,201.13 / $5,251.41 / $8,500.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.00 / $15,914.47 / $15,914.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,314.91 / $6,797.36 / $20,438.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,055.82 / $16,282.88 / $20,093.07
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,608.47 / $6,472.37 / $9,260.83
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,487.31 / $6,055.59 / $9,260.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,282.88 / $16,282.88 / $17,911.16
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,314.91 / $4,314.91 / $4,314.91
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,408.78 / $4,314.91 / $4,314.91